Neurology Unit, Department of Neurology, MS Center, Ospedale San Raffaele, Milan, Italy.
Eur Rev Med Pharmacol Sci. 2022 Feb;26(3):935-946. doi: 10.26355/eurrev_202202_28003.
Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, disimmune disease of the central nervous system whose etiology and pathogenesis remain poorly understood, due to its complex and multifactorial nature. Evidence of a bidirectional connection linking the gut microbiome with the intestinal barrier and the immune system (the gut-brain axis) may have implications for the pathogenesis of inflammatory demyelinating diseases such as MS. This narrative review summarizes the evidence for the gut-brain axis involvement in the pathogenesis of MS and examines the role of gut-oriented interventions in MS.
We reviewed all available studies in PubMed concerning gut-directed interventions and MS. This research was conducted using different combinations of pertinent keywords (multiple sclerosis, immune-mediated inflammatory diseases, autoimmune diseases, first demyelinating event, neurocognition, neurological disorders, neurology practice, risk factors, taxonomic biomarkers, nutrition, diet, dietary additives, complementary treatment, gut bacteria, gut microbiome, microbiome, gut-brain axis, epidemiology, alpha-linolenic acid, fermentative metabolites, fat, saturated fat, monounsaturated fat, polyunsaturated fat, omega-3 fatty acids, calorie restricted diet, fasting, fecal microbiome, fecal microbiota transplantation, animal testing).
There is an emerging evidence that alterations in the gut microbiome and increased intestinal permeability may be causative factors in the complex interplay between nutrition, metabolic status and the immune-inflammatory response in patients with MS. This suggests the possibility that modification of lifestyle and the microbiome, for example by specific diets or fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers, may positively influence the pathogenesis of MS.
Although the role of nutritional factors in the pathogenesis of MS remains to be established, there is evidence that appropriate gut-directed interventions such as diet, nutritional supplementation or fecal transplantation may modulate the inflammatory response and improve the course of MS as a complementary treatment in the disease.
多发性硬化症（MS）是一种慢性、炎症性、脱髓鞘、免疫失调的中枢神经系统疾病，由于其复杂和多因素的性质，其病因和发病机制仍不清楚。肠道微生物组与肠道屏障和免疫系统（肠脑轴）之间存在双向联系的证据，可能对 MS 等炎症性脱髓鞘疾病的发病机制有影响。本综述总结了肠脑轴在 MS 发病机制中的作用，并探讨了肠道导向干预在 MS 中的作用。
我们在 PubMed 上检索了所有关于肠道导向干预和 MS 的研究。这项研究使用了不同的关键词组合，包括多发性硬化症、免疫介导的炎症性疾病、自身免疫性疾病、首次脱髓鞘事件、神经认知、神经障碍、神经病学实践、风险因素、分类生物标志物、营养、饮食、饮食添加剂、补充治疗、肠道细菌、肠道微生物组、微生物组、肠脑轴、流行病学、α-亚麻酸、发酵代谢物、脂肪、饱和脂肪、单不饱和脂肪、多不饱和脂肪、ω-3 脂肪酸、限制卡路里饮食、禁食、粪便微生物组、粪便微生物移植、动物试验。
越来越多的证据表明，肠道微生物组的改变和肠道通透性的增加可能是 MS 患者营养、代谢状态和免疫炎症反应之间复杂相互作用的因果因素。这表明，通过特定的饮食或粪便微生物移植、补充胆酸和肠道屏障增强剂等方法，改变生活方式和微生物组，可能会对 MS 的发病机制产生积极影响。
尽管营养因素在 MS 发病机制中的作用仍有待确定，但有证据表明，适当的肠道导向干预，如饮食、营养补充或粪便移植，可能会调节炎症反应，并改善 MS 的病程，作为疾病的补充治疗。
